BCC is one of the commonest eyelid malignancies in India. While in the west, BCC accounts for nearly 90% of the eyelid malignancies, in the Indian subcontinent, BCC cedes it’s top position to Sebaceous cell carcinoma in India. BCC is a non-melanocytic cancer of the skin arising from basal cells of the epidermis. It is mostly seen on sun exposed areas, particularly in the head and neck region. BCC is caused by skin damage caused by prolonged exposure to ultraviolet light thus explaining the preponderance of this cancer in Caucasian skin which does not have the protective effect of melanin.
The Eyebrow is a unique facial aesthetic unit and it’s importance to the face is apparent only when it is disfigured with loss of the hair bearing skin like in this case. Likewise, reconstruction of the eyebrow is challenging because the thickness and direction of the eyebrow hair which is unique and not easy to replicate with hair transplants from other hair bearing areas.
Blepharophimosis syndrome is also knows as BPES (Blepharophimosis, Ptosis, Epicanthus Inversus Syndrome). It is an autosomal dominant condition usually inherited from parents but not always.
In an earlier era, these tumours would be removed via a craniotomy (brain surgery) by neurosurgeons or a disfiguring open surgery sometimes causing the loss of vision in the involved eye by other surgeons- that’s way too much morbidity for a benign tumour. But with the advent of modern day techniques and skilled oculoplastic surgeons performing orbitotomy today to remove such tumours, this surgery’s risks and complications is very low with the added advantage of a scarless as well as without even having to remove bone. This surgery is followed by a mostly uneventful recovery period.
Ocular Surface Squamous Neoplasia (OSSN) is a spectrum of pre-cancerous and cancerous lesions of the conjunctival epithelium (transparent coat covering the surface of the eye). The good news is that, this type of cancer can be completely cured by surgery and/or chemotherapy eye drops if diagnosed before it becomes an invasive Squamous Cell Carcinoma.
While going home that evening, I reflected on how much technology had advanced that surgeons like me get to perform apparent everyday miracles like this while confidently knowing what it is that we are going after. Couldn’t help but remember Arthur C Clark’s third law:
“Any sufficiently advanced piece of technology is indistinguishable from magic.”
The COVID-19 lockdown was a period when we had stopped elective surgery and were prioritising semi-urgent surgeries and emergencies. But some surgeries can’t wait even if not life threatening. Like this girl who fell down the stairs to have an orbital (eye socket) fracture. The walls of the bony socket holding the eye were broken entrapping the eye muscles- which causes double vision and also making the eye sunken (enophthalmos). This needed early intervention- hence a semi-urgent surgery.
There have been many incredible moments during my career as a surgeon but this story has to be the closest to my heart and will be for a long time to come.